If the same people have been asking the same questions for the last 28 years, does that make them insane?

Summer is well and truly over. As I write this, the promise of blue sky, tantalisingly hidden above a light cloud covering has been replaced by encroaching gloom and the incessant cold rain of autumn. Even the cinema listings are looking meagre.

This summer at the cinema has been superb. A pretty much full-on programme for the first time since the pandemic. Barbenheimer of course – Tom Cruise riding motorbikes off cliffs. Harrison Ford – at least for the first two acts. And then there was the Disney 100 revival season. Who doesn’t love a good re-release? Beauty and the Beast, Jungle Book and of course the classic Toy Story.

Toy Story was first released in 1995. Can you believe it? I had started my pharmacy journey at that point, but only as a lowly Saturday kid. I wouldn’t go to university until the following year. Imagine something from 1995 being re-released in 2023 and still holding its own.

Talking of things released in 1995, let’s talk about Community Pharmacy England’s Vision for Community Pharmacy. Or should I say PSNC’s nattily titled Vision For NHS Community Pharmacies from 2013? What about Pharmacy Voice’s Forward View? Whichever you choose, they all imitate their ultimate progenitor, the Royal Pharmaceutical Society of Great Britain’s 1995 publication Pharmacy In A New Age.

You probably have to go to the British Library to obtain a copy of PIANA, as it was commonly known. The current version of the Society might have a copy or two in the museum, but it probably doesn’t meet their diversity and inclusion criteria these days.

Much has been made of CPE’s new document. And to be fair, it says some very worthy things. But so did PIANA. There is barely anything new in the 2023 document that does not have it roots in the 1995 original. Sure, terms have changed and technology has brought new paradigms to the way you might do things. Structures exist now that didn’t then. This was produced in 1995, 10 years before Medicine Use Reviews were even a thing. Yet the key aspirations are the same.

Pharmacists want to do more than just dispense. Their teams talk to patients more regularly and often more meaningfully than GPs or other diagnosticians. Community pharmacy premises are often in the heart of the most deprived areas and are more accessible than other healthcare settings.

Pharmacists are experts in medicines. Let’s put two and two together and make something greater than the sum of its parts – or at least something that’s more than just dispensing for a couple of quid and margin.

Imagine being a pharmacy student in the late 1990s, or one of the early MRPharmS intakes. There were forward looking, progressive policy documents being produced every 12-18 months, and PIANA was the start of it. You were not just learning to dispense; you were training to be an integral part of the primary care landscape. Degree courses were being restructured to include consultation skills. The world was your oyster. And the documents kept coming. But the policy changes did not.

All of these documents run to the same theme. They say it in different ways, in different fonts and in different primary colours, but when it comes down to it, they are the same. They are a begging letter to the same people.

“The definition of insanity is doing the same thing over and over again and expecting different results.” Albert Einstein probably never said that, but it is a sound guiding principle. Community pharmacy has been asking the same questions of the same people for the last 28 years. 

The names of job titles and organisations may have changed; the names of governmental departments certainly have. But fundamentally the same people have been asking the same decision makers the same question for the last 28 years. Which begs the question: does that mean Community Pharmacy England – in paying two external think tanks a significant sum of money to produce a vision that is essentially a re-release – are insane? 

As always, only time will tell. What is irrefutable is that Einstein (or whoever it was) had a point. If you’ve been asking the same question for 28 years and getting the same rebuttal, perhaps it’s time to start asking different questions. 

In other news, the Community Pharmacy Independent Prescriber Pathway Programme continues to confound and confuse. It appears to be on an inexorable procession to achieving very little. At least one LPC has written to NHS England expressing no faith in it and will not support its implementation in its area. It would not be a surprise if more follow suit. The deadline of a launch by 30 November looks precarious.

Outsider is P3’s anonymous commentator